Georgia Farm Bureau

Benefits & Rates

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.	PPO/MPA	PPO/MPA	PPO/MPA
Services Covered	Year 1 Plan Pays	Year 2 Plan Pays	Year 3 Plan Pays
Type 1: Diagnostic & Preventive Services Oral exams X-rays Cleanings Fluoride treatments Space maintainers	80%	90%	100%
Type 2: Basic Services Simple extractions, fillings Palliative care Denture repair Sealants General anesthesia	60%	70%	80%
Type 3: Major Services Endodontics Periodontics Complex oral surgery Crowns, Inlays/Onlays, Bridges, Dentures	10%	30%	50%
Waiting Period	None	None	None
Annual Deductible (per person)	$50	$50	$50
Deductible waived on D&P?	Yes	Yes	Yes
Annual Maximum (per person)	$1,000	$1,250	$1,500

*Limitations may apply for some benefits. Please refer to your Evidence of Coverage for a list of benefit limitations and exclusions.